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Download File Pacific Journal of Medical Sciences, Vol. 18, No. 1, January 2018 ISSN: 2072 – 1625 ========================================================== PACIFIC JOURNAL OF MEDICAL SCIENCES {Formerly: Medical Sciences Bulletin} ISSN: 2072 – 1625 Pac. J. Med. Sci. (PJMS) www.pacjmedsci.com. Emails: [email protected]; [email protected] STATUS OF IODINE NUTRITION AMONG SCHOOL-AGE CHILDREN IN KARIMUI-NOMANE AND SINA-SINA YONGGOMUGL DISTRICTS IN SIMBU PROVINCE PAPUA NEW GUINEA *Victor J. Temple1, Guapo Kiagi2, Hethy M. Kai1, Hanifa Namusoke3, Karen Codling4, Lazarus Dawa3 and Eileen Dogimab5 1. Micronutrient Research Laboratory, Division of Basic Medical Sciences, School of Medicine and Health Sciences, University of Papua New Guinea 2. Sir Joseph Nombri Memorial-Kundiawa General Hospital, Simbu Province, Papua New Guinea 3. UNICEF Papua New Guinea; 4. Iodine Global Network; 5 National Department of Health PNG *Correspondence to: [email protected] 0 Pacific Journal of Medical Sciences, Vol. 18, No. 1, January 2018 ISSN: 2072 – 1625 ========================================================== STATUS OF IODINE NUTRITION AMONG SCHOOL-AGE CHILDREN IN KARIMUI-NOMANE AND SINA-SINA YONGGOMUGL DISTRICTS IN SIMBU PROVINCE PAPUA NEW GUINEA *Victor J. Temple1, Guapo Kiagi2, Hethy M. Kai1, Hanifa Namusoke3, Karen Codling4, Lazarus Dawa3 and Eileen Dogimab5 1. Micronutrient Research Laboratory, Division of Basic Medical Sciences, School of Medicine and Health Sciences, University of Papua New Guinea 2. Sir Joseph Nombri Memorial-Kundiawa General Hospital, Simbu Province, Papua New Guinea 3. UNICEF Papua New Guinea; 4. Iodine Global Network; 5 National Department of Health PNG *Correspondence to: [email protected] ABSTRACT: Iodine deficiency is regarded as the single most common cause of preventable mental impairment in communities with suboptimal intake of iodine. Universal Salt Iodization is the most effective and sustainable intervention strategy for prevention, control and elimination of iodine deficiency. Urinary iodine concentration is the biochemical indicator for assessing the iodine status of a population. This study was prompted by reports showing evidence of cretinism in Karimui-Nomane district in Simbu province. The major objectives were therefore to assess the availability of adequately iodized salt in households, the per capita discretionary intake of salt per day and the iodine status of school children (age 6 – 12 years) in Karimui-Nomane, the district of concern, and Sina Sina Yonggomugl, a comparison district in Simbu province. Iodine level was assessed in salt samples collected from randomly selected households in both districts. The head of each household completed a questionnaire on knowledge, attitudes and practices related to salt iodization. Urinary iodine concentrations were measured in spot urine samples collected from randomly selected 6 to 12 years old children from selected primary schools in the two districts. 82.4% and 63.8% of salt samples from Karimui-Nomane and Sina Sina Yonggomugl respectively were adequately iodized above the national standard of 30ppm. The mean per capita discretionary intake of salt in households in Karimui-Nomane district was 4.62 ± 0.42 g/day, and in Sina Sina Yonggomugl district was 6.0 ± 2.61g/day. At measured levels of iodization (mean iodine content 34.7ppm and 32.7ppm respectively), this amount of salt would provide the recommended intake of iodine (150ug/day). However, for children in Karimui-Nomane the median UIC was 17.5µg/L and the interquartile range (IQR) was 15.0 – 43.0µg/L. and in Sina Sina Yonggomugl, the median UIC was 57.5µg/L and the IQR was 26.3 – 103.0µg/L, indicating severe and mild iodine deficiency respectively. These apparently conflicting findings may be explained by the fact that only 34% of households in Karimui-Nomane and 72% of households in Sina Sina Yonggomugl had salt on the day of the survey. The results indicate that iodine deficiency is a significant public health problem in Karimui-Nomane and Sina Sina Yonggomugl districts in Simbu province, potentially because of lack of access to salt, rather than inadequate implementation of salt iodization. Further studies are needed to quantify access to salt for communities in areas that are not easily accessible like Karimui-Nomane district in Papua New Guinea and, if inadequate salt access is confirmed, to develop alternative or complementary strategies to salt iodization. Keywords: School children, Iodine deficiency, Salt iodization, Urinary Iodine, Simbu province, Papua New Guinea Submitted November 2017, Accepted December 2017 3 Pacific Journal of Medical Sciences, Vol. 18, No. 1, January 2018 ISSN: 2072 – 1625 ========================================================== INTRODUCTION: salt at the households and a set of programmatic Suboptimal intake or low bioavailability of iodine indicators that are regarded as evidence of can cause inadequate production of thyroid sustainability [1, 2]. Due to wide variation in hormones, which are essential for normal growth iodine excretion during the day and in between and development [1, 2]. Iodine deficiency (ID) individuals, UIC cannot be used to assess iodine can lead to mental retardation in infants and status of individuals. The median value of UICs in children whose mothers were iodine deficient a population can however indicate population during pregnancy. ID is also regarded as the iodine status. As a result, median UICs cannot be single most common cause of preventable used to assess the proportion of individuals with mental impairment in communities with iodine deficiency or excess [1, 3]. suboptimal intake of iodine [1, 2]. Marginal degree of ID can affect “apparently healthy” USI was implemented in Papua New Guinea children – the manifestations may include poor (PNG) in June 1995 with enactment of the PNG performance in psychometric tests, and impaired salt legislation, which prohibits the importation mental and motor functions [1, 2]. ID is usually and sale of non-iodized salt [4, 5]. Reports from diagnosed across a target population and not the PNG National Nutrition Survey in 2005 specifically in an individual [2]. indicated that salt was adequately iodized in 92.5% of the households with salt and iodine Universal salt iodization (USI) is the most status among non-pregnant women of child- effective intervention strategy for the control and bearing age was adequate in the four regions of elimination of ID [1 – 3]. The effective PNG [6]. However, 38% of households had no implementation of USI requires continuous salt at the time of the survey, and iodine status monitoring of the process indicator, which is was lower in women from households without availability of adequately iodized salt in the salt [6]. Meanwhile, several sub-national surveys households and the principal impact indicator, carried out from 1998 to 2016 [7 – 14] indicated which is the iodine status, most commonly prevalence of mild to moderate iodine deficiency assessed by measuring iodine concentration of in some districts in PNG. However, no published single urine samples from a representative data was available on the salt iodization and sample of individuals in target populations [1, 3]. status of iodine nutrition in the Simbu province. The sustainability of USI strategy can be assessed by combination of the median urinary The current study was prompted by the report iodine concentration (UIC) in the target presented by the Chief Pediatrician in Simbu population, the availability of adequately iodized (Chimbu) Province during the midyear 4 Pacific Journal of Medical Sciences, Vol. 18, No. 1, January 2018 ISSN: 2072 – 1625 ========================================================== consultative meeting of the Pediatric Society of the community. Most of the cases were cretins PNG in 2014 [15]. The focus of the report was without goiter. Thus, because of lack of the nutritional status among infants and children appropriate laboratory services, some of the in Karimui-Nomane district in Simbu province. It diagnoses were confirmed by X-rays showing included cases of cretinism and dwarfism suspected characteristics of cretins. diagnosed based on history taking and clinical Two of the X-rays showed delay in the examinations; several photographs of the development of the carpal bones in the wrist, children and family members were displayed. delay in the development of bone centers of The diagnoses included Failure to Thrive (FTT), ossification indicative of congenital very low IQ, severe stunting, delay dentition, hypothyroidism, pronounced trabeculae in the abdominal distention, umbilical hernia, unable to structure of the metaphyses in the distal end of stand and walk and clinical evidence of the femur and the proximal end of the tibia. The hypothyroidism. The Chief Pediatrician also cited Femoral head center of ossification shows traces suspected cases of congenital hypothyroidism in (Figs 1a and 1b). Fig. 1a: X-ray of carpal bones in Fig. 1b: X-ray of distal end of femur the wrist [15] and proximal end of tibia [15] These X-rays are similar to those of patients with exchange for other goods / items and even for hypothyroidism [16, 17]. bride price payments [15]. A similar report was The report further stated that in Karimui-Nomane presented during the midyear consultative district there is a salt water stream that flows out meeting in 2015 because of concerns that no from rocks. The salt water was used to flavour action had been taken [15]. foods by the forefathers of the land, the neighbouring
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